What can buyers do to keep the LMIC ARV market competitive??

Jos PerriënsHIV Department

WHO

The ARV market is concentrating in the hands of a few dominant companies

2004 2006 2009 2012 -

100,000,000

200,000,000

300,000,000

400,000,000

500,000,000

600,000,000

700,000,000

800,000,000

900,000,000

1,000,000,000

Mylan (Matrix Laboratories Ltd.) Hetero Drugs Ltd. Aurobindo Pharma Ltd. Cipla Ltd.Strides Arcolab Ltd. Ranbaxy Laboratories Ltd. Abbott/AbbVie Macleods Pharmaceuticals Ltd.Other suppliers Gilead Sciences, Inc. GlaxoSmithKline Ltd. (ViiV) Aspen Pharmacare Ltd.Emcure Pharmaceuticals Ltd. F. Hoffmann-La Roche Ltd. Merck, Sharp & Dohme Ltd. Varichem Pharmaceuticals (PVT) Ltd.Janssen-Cilag S.p.A. (J&J) Tibotec Boehringer Ingelheim Bristol-Myers Squibb

Do we need "5 +"??

• A difficult case …

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Lopinavir (LPV) + Ritonavir (RTV)

# Producers PQ'd or Stringent Reg Appr. Median Price /PYR in LICand LMIC

• A not so clear case; [ZDV + 3TC]

• Too early to say for "TLE" – but therapeutic competition with "TEE" forced price to "TEE" levels, and then further down.

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Lamivudine (3TC) + Zidovudine (ZDV)

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

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Efavirenz (EFV) + Lamivudine (3TC) + Tenofovir (TDF)

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

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Lamivudine (3TC) + Tenofovir (TDF)

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

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Emtricitabine (FTC) + Tenofovir (TDF)

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

• "5+" works for "TE" and "TL"

2007 2008 2009 2010 2011 2012 20130

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Efavirenz (EFV) + Emtricitabine (FTC) + Tenofovir (TDF)

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

• "5+" works for EFV, for "TE" and "TEE"

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Efavirenz (EFV) 600 mg

# Producers PQ'd or Stringent Reg Appr.Median Price /PYR in LICand LMIC

So "5+" is important

What needs to be done to foster a competitive market for all important

formulations?

Let's think:

• In markets with 5+ suppliers: adapt size of orders from past market participation? +5% for lowest bid, -5% for highest bid?

• For formulations with <5 suppliers: allow recent suppliers a 10% bonus??

• Other ideas??